Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT 4133 | CA |
NPI | 1255621090 |
---|---|
Provider Name | Mrs. Denice Michelle Nielson |
First Address | Mountain House, CA 95391-1126 |
Second Address | Livermore, CA 94550-4115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 13/04/2011 |